Provider Demographics
NPI:1831501998
Name:GONFA, GENET
Entity Type:Individual
Prefix:
First Name:GENET
Middle Name:
Last Name:GONFA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 14TH ST NW
Mailing Address - Street 2:APT 114
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1767
Mailing Address - Country:US
Mailing Address - Phone:703-226-9923
Mailing Address - Fax:
Practice Address - Street 1:6040 14TH ST NW
Practice Address - Street 2:APT 114
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011
Practice Address - Country:US
Practice Address - Phone:703-226-9923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-23
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA9056OtherHHA